Programa de transición: una intervención para adolescentes con diabetes tipo 1: estudio de casos y controles / Transition program: an intervention for adolescents with type 1 diabetes: cases and controls study

Introduction: The transition programs (TP) are planned interventions with specific aims which support type 1 diabetes adolescents in their process to emigrate from a pediatric care system to an adult care system. Objective: To evaluate the effectiveness of a TP in type 1 diabetes adolescents. Subjects and Method: This study was performed in 20 adolescents: 10 in TP and 10 controls (no TP) attended in an adult care system in a traditional way. The applied program included: coordination of attention dates, administrative supervision of the cases, and integral health team attention: physician every three months, psychologist with psychosocial follow-up every three months, nutricionist and university nurse according to the case necessities. After a year of the TP implementation the indicators of adherence were evaluated: continuity of care, regular medical appointments, physician/adolescent relationship, psychosocial follow-up, and to maintain or improve the HbA1c. The statistical analysis of variables comparison was performed with Kwallis Test o Mann-Whitney Test, in STATA 12.0 program. Results: At comparing groups, it was found that the intervened adolescents presented a major frequency of: continuity of diabetes care, regular medical appointments, physician/adolescent relationship and psychosocial follow-up (p < 0,01); the indicator of maintaining or improving the HbA1c was better in the patients with TP (60 percent vs 30 percent) yet not significant. Conclusion: In type 1 diabetes adolescents, with the applied TP we get better indicators of adherence to the diabetes treatment

Experiencia con insulina degludec en pacientes diabéticos Tipo 1 del Hospital San Juan de Dios Santiago / Experience with degludec insulin in Type 1 diabetic patients at the San Juan de Dios Hospital

OBJECTIVE: To study the efficacy and safety of degludec insulin in Type 1 diabetic patients. PATIENTS AND METHOD: In a prospective study, 230 type 1 diabetics patients, average aged 34 years age and 14 years of diagnosis of diabetes and treated with two doses of insulin glargine U-100, were changed to degludec. Patients had glycosylated hemoglobins (HbA1c) greater than 10 percent. Results were recorded at 3 and 6 months with parameters clinical, biochemical, insulin requirements per kilogram of weight (U/kg/wt) and hypoglycemia. Capillary glycemia was evaluated three times a day and the dose of insulin degludec every two weeks. The statistical analysis used was average and rank, standard deviation, normal Swilk test, categorical Chi2 and continuous ANOVA or Kwallis, and p < 0.05. A psychological survey was conducted to evaluate satisfaction with the new treatment. RESULTS: Fasting blood glucose decreased from 253 (range 243-270) at 180 mg/dl (172-240) at 3 months and at 156 (137-180) at 6 months after the change insulin (p < 0.05). HbA1c, initially 10.6 percent (10.4-12.2) decreased to 8.7 percent (9.3-10.1) and 8.3 percent (8.7-9.7) at 3 and 6 months, respectively (p < 0.05). There was a decrease in basal insulin requirements from 0.7 to 0.4 U/kg/60 percent reduction in hypoglycaemia; both mild and moderate and severe. Isolated nocturnal hypoglycaemias were recorded in only 4 patients in this group. CONCLUSION: Six months of treatment with degludec insulin reduces fasting blood glucose, glycosylated hemoglobin and hypoglycemia, both mild and moderate severe and nocturnal, which makes this new ultra-long acting basal insulin a safe and effective tool for the management of type 1 diabetics patients

Cetoacidosis diabética normoglicémica en el embarazo: caso clínico / Normoglycemic diabetic ketoacidosis in pregnancy: report of one case

Normoglycemic diabetic ketoacidosis should be suspected in pregnant women presenting nausea, vomiting, abdominal pain and anorexia. We report a 39 years old woman with a 32 weeks pregnancy who sought emergency care due to hyperemesis. She was hospitalized with the following diagnoses: pregnancy hypertension syndrome, gestational diabetes, morbid obesity and poor prenatal control. The evaluation of the feto-placental unit showed perception of fetal movements, non-reactive non-stress baseline record and a biophysical profile of 6/8. Fetal maturation was initiated. Laboratory tests showed a metabolic acidosis, a low pH, an increased Gap anion, elevated ketonemia and a blood glucose of 172 mg/dl. A diagnosis of normoglycemic diabetic ketoacidosis was formulated and treatment with hydration and regular insulin according to capillary blood glucose levels was started. An emergency caesarean section was performed. The newborn weighed 2.650 kg, had a length of 46 cm, was large for gestational age, had an Apgar score of 2.7, had perinatal asphyxia, convulsive syndrome and a possible congenital cardiopathy. Once the ketoacidosis was resolved during the immediate puerperium, slow acting insulin was initiated.

Disfunción sexual en la mujer diabética pre y postmenopáusica / Sexual dysfunction in women with diabetes in pre and postmenopausic state

Objective: female sexual dysfunction (FSD) in diabetic women, is a topic poorly studied. The aim of this study is to determine the prevalence of FSD in typ1 1 and typ2 diabetic patients (T1D and T2D) compared with non diabetic controls. Patients and Method: interview under written consent 24 diabetic patients attended at Diabetes Unit of the San Juan de Dios Hospital and 24 healthy controls. Inclusion criteria: diagnosis of diabetes mellitus over one year, age 18-75 years old and stable partner for over a year. Exclusion criteria: antidepressants treatment. The validated survey by Rosen et al. was applied. Female Sexual Function Index (FSFI), of 19 questions that assess 6 areas of sexual function: desire, lubrication, excitement, orgasm, satisfaction and pain. A total score of 26.55 or less diagnosed DSF. In diabetic patients the metabolic control, lipid profile, creatinine and glycated hemoglobin A1c (HbA1c) was recorded. Statistical analysis was performed using median, range and Mann Whitney test. Percentages of sexual dysfunction was analysed by chi². It was considered significant at p < 0.05. Results: the results of the FSFI survey were divided and related to menopause. In premenopausal diabetic group (n = 11), the average score was 31.1 versus 32.5 in controls (NS) and in postmenopausal diabetic group (n = 13) the average score was 23,1 versus 28,5 (p = 0.05). The overall frequency of DSF in premenopausal diabetic women was 27.3 percent and 6.3 percent in controls (NS), in postmenopausal reached 69.2 percent and25.0 percent in controls (p = 0.01 ). Conclusion: in diabetic patients sexual dysfunction was more frequent than in controls; in premenopausal women the most affected area is the excitement and in postmenopausal women was lubrication.

Uso de pacientes estandarizados para la adquisición de conocimientos teórico-clínicos en estudiantes de pregrado / Use of standardized patients to the acquisition of clinical-theoretical knowledge by nursing undergraduate students / Uso de pacientes estandardizados para a aquisição de conhecimentos teórico-clínicos em estudantes de pregado

La práctica docente obliga a innovar con metodologías que faciliten el aprendizaje y resguarden los principios éticos que fundamentan el quehacer profesional, como es el caso del uso de los pacientes estandarizados (PE). Objetivo: Evaluar el efecto en los conocimientos sobre esquizofrenia y trastornos del ánimo de una intervención que combina clases teóricas estandarizadas y uso de PE en estudiantes universitarios de pregrado de la asignatura de enfermería psiquiátrica. Método: Diseño cuantitativo descriptivo sobre un universo de 157 estudiantes de enfermería de quinto y sexto semestre de formación. La recolección de los datos se realizó a través de un instrumento de medición de conocimientos sometido a pruebas de validación de contenido. Para el análisis de los datos se utilizó el programa SPSS(r). Resultados: Al medir el efecto de la intervención en la adquisición de conocimientos, se observa que la metodología de clase estandarizada incrementa en promedio un 34% los conocimientos de los estudiantes y el uso de PE contribuye con sobre un 10% adicional. Al combinar ambas estrategias, los conocimientos de los estudiantes se incrementan en 49.3% y 41.9% para esquizofrenia y trastornos del ánimo respectivamente, sin que el estudiante participe de otra instancia de estudio o profundización de los contenidos. Conclusión. El uso de estrategias metodológicas combinadas contribuye a la adquisición de los conocimientos necesarios para la formación de estudiantes de pregrado de enfermería psiquiátrica.

Teaching needs to innovate with methodologies which foster learning while, at the same time, maintain the ethical principles which give base to the professional activities. Such is the case of the use of standardized patients (SP). Objective: To assess the effects of an intervention which combines standardized theoretical classes with the use of SP, on the knowledge which undergraduate students, undergoing their psychiatric nursing subject, have on schizophrenia and mood disorders. Method This was a qualitative and descriptive study on a universe of 157 nursing students from the fifth and sixth semesters of their program. Data collection was conducted through a knowledge assessment instrument which was submitted to content validity tests. The SPSS(r) program was used to analyze these data. Results: From the intervention, it was observed that the methodology of standardized class increments in an average of 34% the students' knowledge, while the use of SP contributes with an additional 10%. When combining both methodologies, and without any other content-deepening technique, the students' knowledge on schizophrenia increased 49.4% while their knowledge on mood disorders increased 41.9%. Conclusion: The use of combined methodological strategies contributes to the acquisition of formation-needed knowledge by undergraduate psychiatric nursing students.

A prática docente obriga a inovar com metodologias que facilitem a aprendizagem e a salvaguardar os princípios éticos que fundamentam o fazer profissional, como é o caso do uso 2 pacientes estandardizados (PE). Objetivo: Avaliar o efeito nos conhecimentos sobre esquizofrenia e transtornos de ânimo de uma intervenção que combina aulas teóricas estandardizadas e uso de PE nos estudantes universitários de pregado da matéria de enfermagem psiquiátrica. Método: Desenho quantitativo descritivo sobre o universo de 157 estudantes de enfermagem de quinto e sexto semestre de formação. A recoleta 2 dados realizou-se a través de um instrumento de medição de conhecimentos submetido a testes de validação de conteúdo. Para a análise de dados utilizou-se o programa SPSS(r). Resultados Ao medir o efeito da intervenção na aquisição de conhecimentos, observa-se que a metodologia de classe estandardizada incrementa em média um 34% os conhecimentos 2 estudantes e o uso de PE contribui sobre um 10% adicional. Ao combinar ambas as estratégias, os conhecimentos 2 estudantes incrementam-se em 49.4% e 41.9% para esquizofrenia e transtornos de ânimo respectivamente, sem que o estudante participe de outra instância de estúdio e/ou aprofundamento 2 conteúdos. Conclusão: O uso de estratégias metodológicas combinadas contribui à aquisição de conhecimentos necessários para a formação de estudantes de pregado de enfermagem psiquiátrica.

Metformina asociada a insulinoterapia en pacientes diabéticos tipo 1 / Metformin associated with insulin therapy in type 1 diabetic patients

In patients with diabetes type 1 (T1D) glycemic control remains suboptimal, despite the availability of new insulin analogues and continuous infusion systems. Metformin may be a complementary therapy regarding to intensified insulin therapy since a significant percentage of T1D have insulin resistance (IR). Objective: To analyze the clinical, anthropometric and metabolic effects of the combination of metformin to insulin therapy in T1D patients. Subjects and Method: 34 T1D patients, 15 men and 19 women, mean age 41 years (range 20-64) metformin 850 mg / day was associated for 6 months (group 1) and retrospectively evaluated 18 T1D, 9 men and 9 women, age average 34 years (range 17-58), who received metformin for 36 months (group 2). It was recorded before and after treatment with metformin: nutritional status, waist circumference, index waist / hip, glucose fasting, glycosylated hemoglobin (HbA1c), HDL cholesterol, triglycerides, systolic and diastolic blood pressure (BP), glucose uptake (UG) and insulin dose (U/kg). Statistical analyses. Clinical and biochemical parameters were expressed as median, range or percentage (percent). For the statistical significance were used chi2and Fisher exact and Mann Whitney test; and was established as significant at p <0.05. Results: In group 1 significantly decreased waist circumference in men and women and improved fasting glucose, HbA1c, systolic blood pressure and triglycerides. In group 2, waist circumference and systolic blood pressure was also reduced. Conclusion: In T1D patients with clinical signs of IR the association of metformin to insulin therapy may be useful.

Alteraciones hematológicas en la diabetes mellitus / Blood disorders in diabetes mellitus

Although it has been treated in a limited way the relationship between diabetes and hematopoietic system, there is evidence demonstrating thedeleterious effect of hyperglycemia on the three cell lines: red blood cells, white cells and platelets. Different forms of anemia associated with hyperglycemia are analyzed and erythrocyte alterations observed in diabetes. In chronic decompensated patients have been demonstrated alterationsof monocytes, lymphocytes and polymorphonuclear particularly, with decreased chemotaxis, adherence, phagocytosis and opsonization. Hyperglycemia determines a prothrombotic state by platelet hyperreactivity, which is a marker of inflammation...

Diabéticos tipo 1 portadores de síndrome metabólico: cuantificación de la resistencia a la insulina / Type 1 diabetics patients carriers of metabolic syndrome: quantification of insulin resistance

The presence of insulin resistance (IR) has been indirectly assessed in Type 1 Diabetics (T1DM) through the detection of Metabolic Syndrome (MS), by applying criteria for Type 2 Diabetics(T2DM). In the EDC study (the Pittsburg Epidemiology of Diabetes Complications) a formula applicable to T1DM was validated, quantifying IR through the glucose uptake (GU) employing the usual clinical and laboratory parameters, in patients with HbA1c < 11.4 percent. Objectives: To determine in T1DM whether there exists a relationship between the presence of MS according to the Modified NCEP/ATPIII criteria and IR quantification through assessment of the glucose uptake or GU. Patients and Method: The modified NCEP/ATPIII criteria were applied to 150 T1DM patients, and those with more than 3 altered parameters were classified as MS carriers. IR was quantified through the glucose uptake (GU), applying the formula for Estimated Glucose Disposal Rate (GDR-EDC). Results: 26.6 percent of the T1DM (40 patients) complied with the modified NCEP/ATPIII criteria. When the formula for GU was applied (31 patient), 90.3 percent of the T1DM showed insulin resistance (GU value < 8.77). And when applied to 124 patients (T1DM with and without MS and HbA1c < 11,4 percent) 75 percent showed IR...

Cáncer radioinducido / Radioinduced cancer

Publications about approximately 2 million irradiated people and their death after irradiation, were reviewed. This review considers only statistically important publications. In 140.000 people exposed to environmental radiation in zones of high background and in 350.000 occupationally exposed within recommended annual doses, no excess cancer was detected. In 1,504,000 people prenatally exposed to low doses (about 1cGY) due to diagnostic radiological examinations, the rate of cancer death before 15 years of age, was similar to unexposed populations. In 195,000 exposed to high radiotherapeutic doses, a variable increase in the incidence of cancer was detected. In 825,000 people that received internal and external irradiation in Chernobyl, no increase in cancer deaths was detected until 1991. In 1993, an increased incidence of thyroid gland carcinoma was preliminarily reported. Finally, in 100,000 people irradiated at Hiroshima and Nagasaki ab excess leukemia rate was found in the group that received doses over 200 cGY

Toxoplasmosis en ninos tratados con drogas de efecto inmunodepresor. / Toxoplasmosis in children treated with immunosupressive drugs

La toxoplasmosis puede constituir una infeccion grave e incluso mortal en inmunodeprimidos. Este trabajo analiza la frecuencia de esta infeccion, mediante estudio serologico, en 129 ninos sometidos a tratamiento prolongado con drogas inmunodepresoras, demostrando que es similar a la poblacion infantil normal. Se demuestra que existe un riesgo bajo de 2,3% de reactivacion de la infeccion por T. gondii con el tratamiento inmunodepresor aunque no despreciable dado las consecuencias de esta infeccion. Se aconseja control serologico seriado de estos ninos y eventual tratamiento especifico, si se demuestra infeccion aguda